Molecular Composition for Enhancing and Rejuvenating Maintenance and Repair of Mammalian Tissues

ABSTRACT

Methods, pharmaceutical compositions, and kits are provided for treating a subject with an effective amount of an oxytocin receptor (OXTR) agonist and an effective amount of an ALK5 antagonist. In certain aspects, the OXTR agonist may be oxytocin or an oxytocin analog (e.g., a small molecule). The ALK 5 antagonist may be a small molecule, such as 2-(3-(6-Methylpyridin-2-yl)-1H-pyrazol-4-yl)-1,5-naphthyridine, LY2157299, A 83-01, D 4476, GW 788388, LY 364947, RepSox, SB 431542, SB 505124, SB 525334, or SD 208. In certain aspects, the amounts of the OXTR agonist and ALK5 antagonist may be sufficient to induce muscle regeneration and/or neural cell regeneration in the subject.

CROSS REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Provisional PatentApplication No. 62/036,473, filed Aug. 12, 2014, which application isincorporated herein by reference in its entirety.

GOVERNMENT RIGHTS

This invention was made with government support under contract R01AG02725201 awarded by National Institutes of Health (NIH) and contractRN1-00532-1 awarded by the California Institute of Regenerative Medicine(CIRM). The Government has certain rights in this invention.

INTRODUCTION

As the average world population is aging rapidly, enhancing the elderlyquality of life is of major importance for both their well-being and forregulating the associated socioeconomic costs. With aging, the capacityof tissues to regenerate declines and eventually fails, leading todegenerative disorders and eventual organ failure. Sarcopenia affectspeople over 50 years old and results in a decrease in the level ofphysical activity causing frailty and disability and the likelihood offalls and fractures. While several treatments that increase muscle masshave been tested to fight this disease, most of them fail in elderlypopulations and the risk to benefit ratio is so high that exercise isstill the primary treatment for the age-specific muscle wasting.

SUMMARY

Methods, pharmaceutical compositions, and kits are provided for treatinga subject with an effective amount of an oxytocin receptor (OXTR)agonist and an effective amount of an ALK5 antagonist. In certainaspects, the OXTR agonist may be oxytocin, an oxytocin analog (e.g.,carbetocin, demoxytocin, TC OT 39, WAY 267464, or a small molecule). TheALK5 antagonist may be a small molecule, such as A 83-01, D 4476, GW788388, LY 364947, RepSox, SB 431542, SB 505124, SB 525334, or SD 208.In certain aspects, the amounts of the OXTR agonist and ALK5 antagonistmay be sufficient to induce muscle regeneration and enhanceneurogenesis, combatting and preventing degenerative disorders in thesubject. In certain aspects, the combined administration of the OXTRagonist and ALK5 antagonist may be sufficient to induce muscleregeneration and enhance neurogenesis at a lower effective concentrationthan that required if only the OXTR agonist or the ALK5 antagonist wasadministered.

Aspects of the methods disclosed here include enhancing proliferation ofa somatic cell. The method may include contacting a somatic cell withoxytocin receptor (OXTR) agonist and ALK5 antagonist, wherein thecontacting is with an amount of the OXTR agonist and ALK5 antagonisteffective to enhance proliferation of the somatic cell.

The contacting may be in vivo, in vitro, or ex vivo. The somatic cellmay be a muscle cell, e.g., a skeletal muscle cell or a myoblast. Thesomatic cell may be an activated satellite cell. The somatic cell may bea neural cell, e.g., a neural stem cell or a neural progenitor cells.The somatic cell may be an adult human stem or an adult human progenitorcell. The somatic cell may be a cell of an aged subject. The somaticcell may be an injured cell. The injury may be caused by a disease. Thesomatic cell may be a diseased cell.

In certain aspects the contacting may include administering the OXTRagonist and the ALK5 antagonist to a subject. The subject may be amammal, for example, a rodent or a primate, e.g., a mouse, rat or ahuman. The subject may be old or suffering from reduction in muscle massor neurons, or reduction in other tissues, such as a reduction causeddue to natural aging process, injury, extended inactivity, disease, andthe like. The subject may be diagnosed as having or susceptible todeveloping a neurodegenerative disease, such as, Alzheimer's disease,Parkinson's disease, Huntington's disease, or dementia. The subject maybe diagnosed as having or susceptible to developing a musculardegeneration. The subject may be suffering from muscular dystrophy dueto disease or muscular atrophy due to inactivity associated with aninjury or disease.

The amount of the OXTR agonist for the contacting step, e.g., foradministering to a subject may be in the range of 7.5 nM-30 nM and theamount of the ALK5 antagonist may be in the range of 0.05 μM-3 μM. Theratio of OXTR agonist to the ALK5 antagonist used for contacting step,e.g., for administering to a subject as disclosed herein may be 1:50,50:1, 1:40, 40:1, 1:30, 30:1, 1:25, 25:1, 1:10, 10:1, 1:5, 5:1, or 1:1.

In certain aspects, the OXTR agonist may be oxytocin. In certainaspects, the ALK5 antagonist may be2-(3-(6-Methylpyridin-2-yl)-1H-pyrazol-4-yl)-1,5-naphthyridine.

In certain aspects, the proliferation of the somatic cell may be reducedas compared to the proliferation of the same type of somatic cell from ayoung subject. For example, the somatic cell may be a precursor cellsuch as a muscle precursor cell or a neural precursor cell.

In certain aspects, the somatic cell may be from a subject who has adisease and the proliferation of the somatic cell may be reduced ascompared to the proliferation of the same type of somatic cell from ahealthy adult subject. For example, the subject may be a human who hasdementia and the proliferation of the hippocampal neural cells may bereduced as compared to hippocampal neural cells of a healthy adultsubject.

In certain aspects, the method may further comprising assessingproliferation of the somatic cell following the contacting and adjustingthe amount of the OXTR agonist and/or the ALK5 antagonist for the nextcontacting step.

Contacting may include administering the OXTR agonist and the ALK5antagonist to a subject. Administering may be systemic or local and maybe continuous or on an administration schedule, such as, bi-daily,daily, bi-weekly, weekly, bi-monthly, or monthly.

In certain aspects, the method may further include assessingproliferation of the somatic cell following the contacting andincreasing or decreasing the amount of the OXTR agonist.

In certain aspects, the method may further include assessingproliferation of the somatic cell following the contacting andincreasing or decreasing the amount of the ALK5 antagonist.

In certain aspects, the method may further include assessingproliferation of the somatic cell following the repeated contacting andadjusting the contacting schedule.

Also provided herein is a composition that includes an OXTR agonist; anALK5 antagonist; and a pharmaceutically acceptable excipient. The amountof the OXTR agonist may be in the range of 7.5 nM-30 nM and the amountof the ALK5 antagonist may be in the range of 0.05 μM-3 μM. The ratio ofthe OXTR agonist to the ALK5 antagonist may be 1:50, 50:1, 1:40, 40:1,1:25, 25:1, 1:10, 10:1, 1:5, 5:1, or 1:1. In certain cases, the OXTRagonist may be oxytocin. In certain cases, the ALK5 antagonist may be2-(3-(6-Methylpyridin-2-yl)-1H-pyrazol-4-yl)-1,5-naphthyridine.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows that CDK inhibitors (CDKIs) increase with age in musclestem cells and neural stem cells.

FIGS. 2A and 2B show that muscle strength and lean body mass decline,while body fat increases with age in mice.

FIGS. 3A-3C depict dose-curve matrix of effects OT, Alk5i and OT+Alk5ion myogenic and neurogenic cell proliferation.

FIGS. 4A and 4B depict in vivo epistasis between TGFβ1 and Oxytocin.

DETAILED DESCRIPTION

Methods, pharmaceutical compositions, and kits are provided for treatinga subject with an effective amount of an oxytocin receptor (OXTR)agonist and an effective amount of an ALK5 antagonist. In certainaspects, the OXTR agonist may be oxytocin, an oxytocin analog (e.g.,carbetocin, demoxytocin, TC OT 39, WAY 267464), or another smallmolecule. The ALK5 antagonist may be a small molecule, such as2-(3-(6-Methylpyridin-2-yl)-1H-pyrazol-4-yl)-1,5-naphthyridine, A 83-01,D 4476, GW 788388, LY 364947, RepSox, SB 431542, SB 505124, SB 525334,or SD 208. In certain aspects, the amounts of the OXTR agonist and ALK5antagonist may be sufficient to induce muscle regeneration and/or neuralcell regeneration in the subject.

Before the present methods and compositions are further described, it isto be understood that this invention is not limited to particular methodor composition described, as such may, of course, vary. It is also to beunderstood that the terminology used herein is for the purpose ofdescribing particular embodiments only, and is not intended to belimiting, since the scope of the present invention will be limited onlyby the appended claims.

Where a range of values is provided, it is understood that eachintervening value, to the tenth of the unit of the lower limit unlessthe context clearly dictates otherwise, between the upper and lowerlimits of that range is also specifically disclosed. Each smaller rangebetween any stated value or intervening value in a stated range and anyother stated or intervening value in that stated range is encompassedwithin the invention. The upper and lower limits of these smaller rangesmay independently be included or excluded in the range, and each rangewhere either, neither or both limits are included in the smaller rangesis also encompassed within the invention, subject to any specificallyexcluded limit in the stated range. Where the stated range includes oneor both of the limits, ranges excluding either or both of those includedlimits are also included in the invention.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although any methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of the present invention, some potential methodsand materials are now described. All publications mentioned herein areincorporated herein by reference to disclose and describe the methodsand/or materials in connection with which the publications are cited. Itis understood that the present disclosure supersedes any disclosure ofan incorporated publication to the extent there is a contradiction.

As will be apparent to those of skill in the art upon reading thisdisclosure, each of the individual embodiments described and illustratedherein has discrete components and features which may be readilyseparated from or combined with the features of any of the other severalembodiments without departing from the scope or spirit of the presentinvention. Any recited method can be carried out in the order of eventsrecited or in any other order which is logically possible.

It must be noted that as used herein and in the appended claims, thesingular forms “a”, “an”, and “the” include plural referents unless thecontext clearly dictates otherwise. Thus, for example, reference to “acell” includes a plurality of such cells and reference to “the peptide”includes reference to one or more peptides and equivalents thereof,e.g., polypeptides, known to those skilled in the art, and so forth.

The publications discussed herein are provided solely for theirdisclosure prior to the filing date of the present application. Nothingherein is to be construed as an admission that the present invention isnot entitled to antedate such publication by virtue of prior invention.Further, the dates of publication provided may be different from theactual publication dates which may need to be independently confirmed.

Definitions

The terms “treatment”, “treating” and the like as used herein refer toobtaining a desired pharmacologic and/or physiologic effect. The effectmay be prophylactic in terms of completely or partially preventing adisease or symptom thereof and/or may be therapeutic in terms of apartial or complete cure for a disease and/or adverse effectattributable to the disease. “Treatment” as used herein covers anytreatment of a disease in a mammal, and includes: (a) preventing thedisease from occurring in a subject which may be predisposed to thedisease but has not yet been diagnosed as having it; (b) inhibiting thedisease, i.e., arresting its development; or (c) relieving the disease,i.e., causing regression of the disease.

An “inhibitor” or “antagonist” as used herein refers to any agent (e.g.,small molecule, macromolecule, peptide, etc.) that reduces the activityof an enzyme or receptor. A “Competitive inhibitor” as used hereinrefers to an inhibitor that reduces binding of a substrate to an enzymeor receptor, such as the binding of a ligand to a sell surface receptor.The competitive inhibitor may specifically bind to the active site ofthe enzyme or an allosteric site of the enzyme, or may specifically bindthe substrate itself. “Non-competitive inhibitor” as used herein refersto an inhibitor that reduces activity of an enzyme regardless of thepresence of the substrate. A non-competitive inhibitor may bind to anactive site of the enzyme or to an allosteric site of the enzyme.

As used herein, an “oxytocin analog” refers to a peptide having asimilar amino acid sequence to oxytocin, with one or more amino acidsubstitutions, unnatural amino acids, side chain modifications, or anyother suitable modification.

The terms “individual,” “subject,” “host,” and “patient,” are usedinterchangeably herein and refer to any mammalian subject for whomdiagnosis, treatment, or therapy is desired, particularly humans.

The terms “specific binding,” “specifically binds,” and the like, referto the preferential binding of a binding element (e.g., one binding pairmember to the other binding pair member of the same binding pair)relative to other molecules or moieties in a solution or reactionmixture. The binding element may specifically bind (e.g., covalently ornon-covalently) to a particular epitope or narrow range of epitopeswithin the cell. In certain aspects, the binding element non-covalentlybinds to a target.

The term “effective amount” as used herein refer to the amount of anagent (e.g., dosage, concentration in plasma, etc.) that elicits adesired biological effect, such as enhancing or suppressing thesignaling of a cell surface receptor (e.g., OXTR or ALK5) or inducingtissue regeneration (e.g., muscle regeneration). Effective amounts mayreadily be determined empirically from assays, from safety andescalation and dose range trials, individual clinician-patientrelationships, as well as in vitro and in vivo assays such as thosedescribed in the art.

By “IC50” is intended the concentration of an antagonist required toachieve 50% inhibition of a specific biological or biochemical function,such as ALK5 signaling. By “EC50” is intended the plasma concentrationrequired for obtaining 50% of a maximum biological effect.

The term “sarcopenia” as used herein refers to the degenerative loss ofskeletal muscle mass and/or strength, and is associated with aging. Incontrast, “muscle regeneration” as used herein refers to the increase inmuscle (e.g., skeletal muscle) mass or strength upon treatment.

The term “neurogenesis” as used herein refers to the generation of newneurons in adult mammalian brain (primarily, but not exclusively, inhippocampus, region of brain responsible for learning and memory).

General methods in molecular and cellular biochemistry can be found insuch standard textbooks as Molecular Cloning: A Laboratory Manual, 3rdEd. (Sambrook et al., HaRBor Laboratory Press 2001); Short Protocols inMolecular Biology, 4th Ed. (Ausubel et al. eds., John Wiley & Sons1999); Protein Methods (Bollag et al., John Wiley & Sons 1996); NonviralVectors for Gene Therapy (Wagner et al. eds., Academic Press 1999);Viral Vectors (Kaplift & Loewy eds., Academic Press 1995); ImmunologyMethods Manual (I. Lefkovits ed., Academic Press 1997); and Cell andTissue Culture: Laboratory Procedures in Biotechnology (Doyle &Griffiths, John Wiley & Sons 1998), the disclosures of which areincorporated herein by reference.

OXTR Agonists

The oxytocin receptor (OXTR) is a G-protein coupled receptor for thepeptide oxytocin, which acts a hormone and neurotransmitter. Oxytocin isFDA approved and sold under the name of Pitocin and Syntocinon. Aspectsof the invention include an OXTR agonist (such as oxytocin) or the usethereof.

An OXTR agonist is any agent that specifically enhances OXTR expression,OXTR signaling, or signaling downstream of the OXTR. In certain aspects,the OXTR agonist may include oxytocin (e.g., Pitocin, Syntocinon orgeneric oxytocin) or an oxytocin mimetic, i.e., a peptide having asimilar amino acid sequence to oxytocin, one or more amino acidsubstitutions, unnatural amino acids, or any other suitablemodification. An oxytocin analog of the subject invention may be 8 or 9amino acids in length. An oxytocin analog may have one or more, two ormore, three or more, or four or more chemical modifications as comparedto oxytocin.

Examples of oxytocin analogs that act as OXTR agonists includeDemoxytocin, Carbetocin, TC OT 39 and WAY-267464 (e.g., WAY-267464dihydrochloride), or a derivative thereof. Demoxytocin (also known asSandopart or deaminooxytocin) is an analogue of oxytocin, and an OXTRagonist. Demoxytocin has an IUPAC name of2-[(1-{[13-(butan-2-yl)-10-(2-carbamoylethyl)-7-(carbamoylmethyl)-16-[(4-hydroxyphenyl)methy]-6,9,12,15,18-pentaoxo-1,2-dithia-5,8,11,14,17-pentaazacycloicosan-4-yl]carbonyl}pyrrolidin-2-yl)formamido]-N-(carbamoylmethyl)-4-methylpentanamideand a Chemical Abstracts Service registry number (CAS number) of113-78-0. Carbetocin (also known as Duratocin, Pabal, Lonactene) is aneight amino acid long oxytocin analogue that primarily agonizesperipherally expressed oxytocin receptors. Carbetocin has an IUPAC nameof(2S)-1-[(3S,6S,9S,12S,15S)-12-[(2S)-butan-2-yl]-9-(2-carbamoylethyl)-6-(carbamoylmethyl)-15-[(4-hydroxyphenyl)methyl]-16-methyl-5,8,11,14,17-pentaoxo-1-thia-4,7,10,13,16-pentazacycloicosane-3-carbonyl]-N-[1S)-1-(carbamoylmethylcarbamoyl)-3-methyl-butyl]pyrrolidine-2-carboxamideand a CAS number of 37025-55-1. TC OT 39 is a non-peptide oxytocinanalog and partial agonist of OXTR and vasopressin V2 receptors. TC OT39 has an IUPAC name of(2S)—N-[[4-[(4,10-Dihydro-1-methylpyrazolo[3,4-b][1,5]benzodiazepin-5(1H)-yl)carbonyl]-2-methylphenyl]methyl]-2-[(hexahydro-4-methyl-1H-1,4-diazepin-1-yl)thioxomethyl]-1-pyrrolidinecarboxamideand a CAS number of 479232-57-0. WAY-267464 is a non-peptide oxytocinanalogue and OXTR agonist with minimal affinity for vasopressinreceptors. WAY-267464 has an IUPAC name of4-(3,5-dihydroxybenzyl)-N-(2-methyl-4-[(1-methyl-4,10-dihydropyrazolo[3,4-b][1,5]benzodiazepin-5(1H)-yl)carbonyl]benzyl)piperazine-1-carboxamideand a CAS number of 847375-16-0.

In certain aspects, the OXTR agonist may be a small molecule. Forexample, the OXTR agonist may be 1 kDa or less, 900 Da or less, 800 Daor less, 700 Da or less, 600 Da or less, 500 Da or less, 400 Da or less,300 Da or less, 200 Da or less, or 100 Da or less. Small moleculecompounds may be dissolved in water or alcohols or solvents such as DMSOor DMF, and diluted into water or an appropriate buffer prior to beingprovided to cells. The OXTR agonist may optionally include a moietypreventing transport across the blood brain barrier (BBB).

OXTR agonists are well known in the art, as evidenced by U.S. Pat. No.8,748,564 and U.S. Publication Nos. US20070117794 and US20130085106, thedisclosures of which are incorporated herein by reference.

In certain aspects, the OXTR agonists may include an OXTR specificbinding member. The terms “specific binding,” “specifically binds,” andthe like, refer to the preferential binding of a domain (e.g., onebinding pair member to the other binding pair member of the same bindingpair) relative to other molecules or moieties in a solution or reactionmixture. The binding domain may specifically bind (e.g., covalently ornon-covalently) to a particular epitope or narrow range of epitopeswithin the cell. In such instances, the OXTR specific binding memberassociation with OXTR may be characterized by a KD (dissociationconstant) of 10⁻⁵ M or less, 10⁻⁶ M or less, such as 10⁻⁷ M or less,including 10⁻⁸ M or less, e.g., 10⁻⁹ M or less, 10⁻¹⁰ M or less, 10⁻¹¹ Mor less, 10⁻¹² M or less, 10⁻¹³ M or less, 10⁻¹⁴ M or less, 10⁻¹⁵ M orless, including 10⁻¹⁶ M or less.

A variety of different types of specific binding members may beemployed. Binding members of interest include, but are not limited to,antibodies, proteins, peptides, haptens, nucleic acids, aptamers, etc.In certain aspects, the OXTR specific binding member may be an antibodyor a fragment thereof. The term “antibody” as used herein includespolyclonal or monoclonal antibodies or fragments thereof that aresufficient to bind to an analyte of interest. The fragments can be, forexample, monomeric Fab fragments, monomeric Fab∝ fragments, or dimericF(ab)′2 fragments. Also within the scope of the term “antibody” aremolecules produced by antibody engineering, such as single-chainantibody molecules (scFv) or humanized or chimeric antibodies producedfrom monoclonal antibodies by replacement of the constant regions of theheavy and light chains to produce chimeric antibodies or replacement ofboth the constant regions and the framework portions of the variableregions to produce humanized antibodies.

In certain embodiments, the OXTR agonist may be an agent that modulates,e.g., enhances, expression of functional OXTR. OXTR expression may beenhanced using any convenient means, including use of an agent thatenhances OXTR expression, such as, but not limited to vectors (e.g.,plasmids, retroviruses, etc.) encoding functional OXTR under aninducible promoter, tissue specific promoter, or may be constitutivelyexpressed.

ALK5 Antagonists

Activin A receptor type II-like kinase (ALK5), also known astransforming growth factor beta receptor I (TGF-β receptor), is aserine/threonine kinase receptor expressed in a variety of tissues. Alk5inhibitors are undergoing several clinical trials for treating cancersand attenuating metastasis. Certain aspects of the invention include anALK5 antagonist (i.e., an ALK5 inhibitor) or the use thereof.

An ALK5 antagonist is any agent that specifically reduces OXTRexpression, ALK5 signaling, or signaling downstream of the OXTR.Examples of ALK5 agonists include competitive inhibitors andnon-competitive inhibitors. An ALK5 agonist may bind TGF-β or the TGF-βreceptor.

In certain aspects, the ALK5 antagonist may be a small molecule. Forexample, the ALK5 antagonist may be 1 kDa or less, 900 Da or less, 800Da or less, 700 Da or less, 600 Da or less, 500 Da or less, 400 Da orless, 300 Da or less, 200 Da or less, or 100 Da or less. Small moleculecompounds may be dissolved in water or alcohols or solvents such as DMSOor DMF, and diluted into water or an appropriate buffer prior to beingprovided to cells. The small molecule may be a competitive inhibitor ofALK5-TGF-β binding or a non-competitive inhibitor of ALK5 activity.

Examples of ALK5 antagonists include2-(3-(6-Methylpyridin-2-yl)-1H-pyrazol-4-yl)1)-1,5-naphthyridine,galunisertib (LY2157299 monohydrate), A 83-01, D 4476, GW 788388, LY364947, RepSox, SB 431542, SB 505124, SB 525334, and SD 208, or aderivative thereof. A 83-01 is a selective inhibitor of ALK4, ALK5 andALK7. A 83-01has an IUPAC name of3-(6-Methyl-2-pyridinyl)-N-phenyl-4-(4-quinolinyl)-1H-pyrazole-1-carbothioamideand a Chemical Abstracts Service registry number (CAS number) of909910-43-6. D 4476 is an inhibitor of ALK5 and CK1. D 4476 has an IUPACname of4-[4-(2,3-Dihydro-1,4-benzodioxin-6-yl)-5-(2-pyridinyl)-1H-imidazol-2-yl]benzamideand a CAS number of 301836-43-1. GW 788388 is a selective inhibitor ofALK5. GW 788388 has an IUPAC name of 4-[4-[3-(2-Pyridinyl)-1H-pyrazol-4-yl]-2-pyridinyl]-N-(tetrahydro-2H-pyran-4-yl)-benzamide anda CAS number of 452342-67-5. LY 364947 (also known as HTS 466284) is aselective inhibitor of ALK5. LY 364947 has an IUPAC name of4-[3-(2-Pyridinyl)-1H-pyrazol-4-yl]-quinoline and a CAS number of396129-53-6. RepSox (also known as E-616452 and SJN 2511) is a selectiveinhibitor of ALK5. RepSox has an IUPAC name of2-(3-(6-Methylpyridine-2-yl)-1H-pyrazol-4-yl)-1,5-naphthyridine and aCAS number of 446859-33-2. SB 431542 is a selective inhibitor of ALK4,ALK5 and ALK7. SB 431542 has an IUPAC name of 4-[4-(1,3-benzodioxol-5-yl)-5-(2-pyridinyl)-1H-imidazol-2-yl]benzamide and a CAS number of301836-41-9. SB 505124 is a selective inhibitor of ALK4, ALK5 and ALK7.SB 505124 has an IUPAC name of 2-[4-(1,3-Benzodioxol-5-yl)-2-(1,1-dimethylethyl)-1H-imidazol-5-yl]-6-methyl-pyridine and aCAS number of 694433-59-5. SB 525334 is a selective inhibitor of ALK5.SB 525334 has an IUPAC name of6-[2-(1,1-Dimethylethyl)-5-(6-methyl-2-pyridinyl)-1H-imidazol-4-yl]quinoxalineand a CAS number of 356559-20-1. SD 208 is an ATP-competitive ALK5inhibitor. SD 208 has an IUPAC name of2-(5-Chloro-2-fluorophenyl)-4-[(4-pyridyl)amino]pteridine and a CASnumber of 627536-09-8.

ALK5 antagonists are well known in the art, as evidenced by USPublication Nos. US20060194845, US20050245520, and US20040266842, thedisclosures of which are incorporated herein by reference.

In certain aspects, the ALK5 antagonists may include an ALK5 specificbinding member. The terms “specific binding,” “specifically binds,” andthe like, refer to the preferential binding of a domain (e.g., onebinding pair member to the other binding pair member of the same bindingpair) relative to other molecules or moieties in a solution or reactionmixture. The binding domain may specifically bind (e.g., covalently ornon-covalently) to a particular epitope or narrow range of epitopeswithin the cell. In such instances, the ALK5 specific binding memberassociation with ALK5 may be characterized by a KD (dissociationconstant) of 10⁻⁵ M or less, 10⁻⁶ M or less, such as 10⁻⁷ M or less,including 10⁻⁸ M or less, e.g., 10⁻⁹ M or less, 10⁻¹⁰ M or less, 10⁻¹¹ Mor less, 10⁻¹² M or less, 10⁻¹³ M or less, 10⁻¹⁴ M or less, 10⁻¹⁵ M orless, including 10⁻¹⁶ M or less.

A variety of different types of specific binding members may beemployed. Binding members of interest include, but are not limited to,antibodies, proteins, peptides, haptens, nucleic acids, aptamers, etc.In certain aspects, the ALK5 specific binding member may be an antibodyor a fragment thereof. The term “antibody” as used herein includespolyclonal or monoclonal antibodies or fragments thereof that aresufficient to bind to an analyte of interest. The fragments can be, forexample, monomeric Fab fragments, monomeric Fab′ fragments, or dimericF(ab)′2 fragments. Also within the scope of the term “antibody” aremolecules produced by antibody engineering, such as single-chainantibody molecules (scFv) or humanized or chimeric antibodies producedfrom monoclonal antibodies by replacement of the constant regions of theheavy and light chains to produce chimeric antibodies or replacement ofboth the constant regions and the framework portions of the variableregions to produce humanized antibodies.

In certain embodiments, the ALK5 antagonist may be an agent thatmodulates, e.g., inhibits, expression of functional ALK5. Inhibition ofALK5 expression may be accomplished using any convenient means,including use of an agent that inhibits ALK5 expression, such as, butnot limited to: antisense agents, RNAi agents, agents that interferewith transcription factor binding to a promoter sequence of the ALK5gene, or inactivation of the ALK5 gene, e.g., through recombinanttechniques, etc.

For example, antisense molecules can be used to down-regulate expressionof ALK5 in the cell. The anti-sense reagent may be antisenseoligodeoxynucleotides (ODN), such as synthetic ODN having chemicalmodifications from native nucleic acids, nucleic acid constructs thatexpress such anti-sense molecules as RNA, and so forth. The antisensesequence may be complementary to the mRNA of the targeted protein (i.e.,ALK5). Antisense molecules inhibit gene expression through variousmechanisms, e.g., by reducing the amount of mRNA available fortranslation, through activation of RNAse H, or steric hindrance. One ora combination of antisense molecules may be administered, where acombination may include multiple different sequences.

Antisense molecules may be produced by expression of all or a part ofthe target gene sequence in an appropriate vector, where thetranscriptional initiation is oriented such that an antisense strand isproduced as an RNA molecule. Alternatively, the antisense molecule maybe a synthetic oligonucleotide. Antisense oligonucleotides may be atleast 7 nucleotides in length, at least 10 nucleotides in length, atleast 15 nucleotides in length, at least 20 nucleotides in length, 500or fewer nucleotides in length, 100 or fewer nucleotides in length, 50or fewer nucleotides in length, 25 or fewer nucleotides in length,between 7 and 50 nucleotides in length, between 10 and 25 nucleotides inlength, and so forth, where the length is governed by efficiency ofinhibition, specificity, including absence of cross-reactivity, and thelike.

A specific region or regions of the endogenous sense strand mRNAsequence may be chosen to be complemented by the antisense sequence.Selection of a specific sequence for the oligonucleotide may use anempirical method, where several candidate sequences are assayed forinhibition of expression of the target gene in an in vitro or animalmodel. A combination of sequences may also be used, where severalregions of the mRNA sequence are selected for antisense complementation.

Antisense oligonucleotides may be chemically synthesized by methodsknown in the art (see Wagner et al. (1993), supra, and Milligan et al.,supra.) Oligonucleotides may be chemically modified from the nativephosphodiester structure, in order to increase their intracellularstability and binding affinity. A number of such modifications have beendescribed in the literature, which alter the chemistry of the backbone,sugars or heterocyclic bases.

Among useful changes in the backbone chemistry are phosphorothioates;phosphorodithioates, where both of the non-bridging oxygens aresubstituted with sulfur; phosphoroamidites; alkyl phosphotriesters andboranophosphates. Achiral phosphate derivatives include3′-O′-5′-S-phosphorothioate, 3′-S-5′-O-phosphorothioate,3′-CH₂-5′-O-phosphonate and 3′-NH-5′-O-phosphoroamidate. Peptide nucleicacids replace the entire ribose phosphodiester backbone with a peptidelinkage. Sugar modifications are also used to enhance stability andaffinity. The α-anomer of deoxyribose may be used, where the base isinverted with respect to the natural β-anomer. The 2′-OH of the ribosesugar may be altered to form 2′-O-methyl or 2′-O-allyl sugars, whichprovides resistance to degradation without comprising affinity.Modification of the heterocyclic bases must maintain proper basepairing. Some useful substitutions include deoxyuridine fordeoxythymidine; 5-methyl-2′-deoxycytidine and 5-bromo-2′-deoxycytidinefor deoxycytidine. 5-propynyl-2′-deoxyuridine and5-propynyl-2′-deoxycytidine have been shown to increase affinity andbiological activity when substituted for deoxythymidine anddeoxycytidine, respectively.

As an alternative to anti-sense inhibitors, catalytic nucleic acidcompounds, e.g. ribozymes, anti-sense conjugates, etc. may be used toinhibit gene expression. Ribozymes may be synthesized in vitro andadministered to the patient, or may be encoded on an expression vector,from which the ribozyme is synthesized in the targeted cell (forexample, see International patent application WO 9523225, and Beigelmanet al. (1995), Nucl. Acids Res. 23:4434-42). Examples ofoligonucleotides with catalytic activity are described in WO 9506764.Conjugates of anti-sense ODN with a metal complex, e.g.terpyridylCu(II), capable of mediating mRNA hydrolysis are described inBashkin et al. (1995), Appl. Biochem. Biotechnol. 54:43-56.

In addition, the transcription level of an ALK5 can be regulated by genesilencing using RNAi agents, e.g., double-strand RNA (Sharp (1999) Genesand Development 13: 139-141). RNAi, such as double-stranded RNAinterference (dsRNAi) or small interfering RNA (siRNA), has beenextensively documented in the nematode C. elegans (Fire, A., et al,Nature, 391, 806-811, 1998) and routinely used to “knock down” genes invarious systems. RNAi agents may be dsRNA or a transcriptional templateof the interfering ribonucleic acid which can be used to produce dsRNAin a cell. In these embodiments, the transcriptional template may be aDNA that encodes the interfering ribonucleic acid. Methods andprocedures associated with RNAi are also described in WO 03/010180 andWO 01/68836, all of which are incorporated herein by reference. dsRNAcan be prepared according to any of a number of methods that are knownin the art, including in vitro and in vivo methods, as well as bysynthetic chemistry approaches. Examples of such methods include, butare not limited to, the methods described by Sadher et al. (Biochem.Int. 14:1015, 1987); by Bhattacharyya (Nature 343:484, 1990); and byLivache, et al. (U.S. Pat. No. 5,795,715), each of which is incorporatedherein by reference in its entirety. Single-stranded RNA can also beproduced using a combination of enzymatic and organic synthesis or bytotal organic synthesis. The use of synthetic chemical methods enableone to introduce desired modified nucleotides or nucleotide analogs intothe dsRNA. dsRNA can also be prepared in vivo according to a number ofestablished methods (see, e.g., Sambrook, et al. (1989) MolecularCloning: A Laboratory Manual, 2nd ed.; Transcription and Translation (B.D. Hames, and S. J. Higgins, Eds., 1984); DNA Cloning, volumes I and II(D. N. Glover, Ed., 1985); and Oligonucleotide Synthesis (M. J. Gait,Ed., 1984, each of which is incorporated herein by reference in itsentirety). A number of options can be utilized to deliver the dsRNA intoa cell or population of cells such as in a cell culture, tissue, organor embryo. For instance, RNA can be directly introduced intracellularly.Various physical methods are generally utilized in such instances, suchas administration by microinjection (see, e.g., Zernicka-Goetz, et al.(1997) Development 124:1133-1137; and Wianny, et al. (1998) Chromosoma107: 430-439). Other options for cellular delivery includepermeabilizing the cell membrane and electroporation in the presence ofthe dsRNA, liposome-mediated transfection, or transfection usingchemicals such as calcium phosphate. A number of established genetherapy techniques can also be utilized to introduce the dsRNA into acell. By introducing a viral construct within a viral particle, forinstance, one can achieve efficient introduction of an expressionconstruct into the cell and transcription of the RNA encoded by theconstruct.

Methods of Treatment

Aspects of the invention are directed to a method of treating a subject.The method may include administering an oxytocin receptor (OXTR) agonistand an ALK5 antagonist to the subject. As described above, the OXTRagonist may be any agent that specifically enhances OXTR expression,OXTR signaling, or signaling downstream of the OXTR and the ALK5antagonist may be any agent that specifically reduces ALK5 expression orALK5 signaling. In certain aspects the OXTR agonist may be oxytocin. Incertain aspects the ALK5 antagonist may be galunisertib (LY2157299monohydrate). The amount of the OXTR agonist and ALK5 antagonistadministered in the subject methods may be effective to achieve any of anumber of desired outcomes, as discussed below.

A combination of oxytocin (or another OXTR agonist) with Alk5 inhibitoris expected to potentiate the positive effects on muscle, bone, combatage-related fat deposition and promote and rejuvenate hippocampalneurogenesis (leading to increase in memory and cognition and preventingloss of memory and cognition in the elderly).

The amount of the OXTR agonist and ALK5 antagonist may therefore beeffective to enhance fat distribution, prevent or reduce weight gainafter menopause, treat or prevent osteoporosis, enhance wound healing,enhance cognition, reduce memory loss, enhance liver regeneration,restore productive hematopoiesis and/or broadly improve tissuemaintenance and repair in an elderly subject. Unlike many othersubstances that are postulated to enhance tissue regeneration, oxytocinis not associated with cancers, e.g. is not oncogenic and Alk5inhibitors are in fact anti-oncogenic and are in clinical trials forsuppressing metastasis (Inman, G. J. (2011). Switching TGFbeta from atumor suppressor to a tumor promoter. Current opinion in genetics &development 21, 93-99.). Thus, a combination of oxytocin (or anotherOXTR agonist) with Alk5 inhibitor will be used to improve the health ofmultiple tissues, particularly, in the elderly, while minimizing theside effects associated with oncogenesis. The same combination may alsobe used to promote regeneration of tissue after injury in youngerpatients.

In certain aspects, the amount of the OXTR agonist and ALK5 antagonistmay be effective to treat sarcopenia, promote muscle regeneration (e.g.,after injury, after long term immobilization (e.g., due to bed rest,cast, coma), after stroke, after or upon exposure to low gravity, etc.),and/or to prevent muscle loss and cachexia developed with aging or longterm immobility. Alternatively or in addition, the amount of the OXTRagonist and ALK5 antagonist may be effective to attenuate persistent,excessive inflammation, such as is seen in arthritic, certainauto-immune diseases, and severe trauma.

In certain aspects, the amount of the OXTR agonist and ALK5 antagonistmay be effective to prevent or treat age related cosmetic changes. Forexample, the amount of the OXTR agonist and ALK5 antagonist may beeffective to prevent or treat wrinkles, prevent hair loss, promote hairregrowth, etc.

Effective amounts of the OXTR agonist and/or ALK5 antagonist may readilybe determined empirically from assays, from safety and escalation anddose range trials, individual clinician-patient relationships, as wellas in vitro and in vivo assays such as those described in the art (e.g.,Reagan-Shaw et al. (2007) The FASEB Journal 22:659-661).

The subject may be any suitable animal, such as a rodent (e.g., mouse,rat, etc.), primate (e.g., human, monkey, etc.), and so forth. In oneembodiment, the subject may be a mouse. In certain embodiments, thesubject may be a human. The subject may have sarcopenia, muscle injury,cachexia, arthritis, an auto-immune disease, severe trauma,osteoporosis, obesity and related metabolic disorders, or any diseaseinvolving degeneration of tissue. In certain aspects, subject may beelderly, e.g., 60 years or older, 65 years or older, 70 years or older,75 years or older, 80 years or older, 85 years or older, 90 years orolder, and so forth. The subject may be a male or a female subject.

The OXTR agonist and ALK5 antagonist may be administered by any suitableroute of administration, such as by enteric administration (e.g., oral)or by parenteral administration (e.g., intravenous, intra-arterial,intra-muscular, subcutaneous, etc.). For example, the OXTR agonist andALK5 antagonist may be delivered by daily injections, nasal spray, usingpump, delivered topically as a cream or using patches, oral tablets thatprevent degradation of these bioactive molecules by the gastrointestinaltract. In addition, the OXTR agonist and/or ALK5 antagonist may beincorporated into a variety of formulations for therapeuticadministration, according to any of the embodiments discussed herein. Incertain cases, the OXTR agonist and ALK5 antagonist may be administereddirectly into a location in the body, such as, injured muscle, bone, aregion of the brain (e.g., hippocampus), and the like.

In certain embodiments, the amount of an ALK5 antagonist to beadministered may be gauged from the IC50 of the given ALK5 antagonist.By “IC50” is intended the concentration of an antagonist required toachieve 50% inhibition of a specific biological or biochemical function,such as ALK5 signaling.

With respect to the ALK5 antagonists of the present disclosure, aneffective amount (e.g., the amount to be administered) may be 200× thecalculated IC50 or less. For example, the amount (e.g., effectiveamount, amount to be administered, etc.) of an OXTR agonist and/or ALK5antagonist may be 200× or less, 150× or less, 100× or less, 75× or less,60× or less, 50× or less, 45× or less, 40× or less, 35× or less, 30× orless, 25× or less, 20× or less, 15× or less, 10× or less, 8× or less, 5×or less, 2× or less, 1× or less, 0.5× or less, or 0.25× or less than thecalculated IC50. In one embodiment, the effective amount may be 1× to100×, 2× to 40×, 5× to 30×, or 10× to 20× of the calculated IC50.

With respect to OXTR agonists and ALK5 antagonists of the presentdisclosure, the effective amount (amount to be administered) may begauged from the EC50. By “EC50” is intended the plasma concentrationrequired for obtaining 50% of a maximum biological effect. Suitablebiological effects include binding of the OXTR agonist to OXTR, bindingof the ALK5 antagonist to ALK5, OXTR agonist effect on OXTR signaling,ALK antagonist effect on ALK5 signaling, and/or downstream effects suchas cell regeneration. An effective amount may be 200× the calculatedEC50 or less. The amount (e.g., effective amount, amount to beadministered, etc.) of an OXTR agonist and/or ALK5 antagonist may be200× or less, 150× or less, 100× or less, 75× or less, 60× or less, 50×or less, 45× or less, 40× or less, 35× or less, 30× or less, 25× orless, 20× or less, 15× or less, 10× or less, 8× or less, 5× or less, 2×or less, 1× or less, 0.5× or less, or 0.25× or less than the calculatedEC50. In one embodiment, the effective amount may be 1× to 100×, 2× to40×, 5× to 30×, or 10× to 20× of the calculated EC50.

The OXTR agonist and ALK5 antagonist may exhibit a synergistic effect.As such, the effective amounts of the OXTR agonist and ALK5 antagonistmay be less, e.g., half as much or less, than the effective amount ofeither agent alone.

Targeting and calibrating to healthy levels of distinct pathways (MAPKby OXTR agonist and TGF-beta by Alk5 antagonist) may promote a broadimprovement in function of most mammalian cells, because MAPK and TGF-βsignaling are the key cell-fate regulators.

In certain aspects, the OXTR agonist may be oxytocin administered byinfusion or by local injection, e.g., by intravenous infusion at a rateof 0.01 μg/h to 100 μg/h, including 0.1 μg/h to 10 μg/h, 0.5 μg/h to 5μg/h, etc. Administration (e.g., by infusion) can be repeated over adesired period, e.g., repeated over a period of 1 day to 5 days or onceevery several days, for example, five days, over 1 month, 2 months, etc.It also can be administered prior, at the time of, or after othertherapeutic interventions. Alternatively, oxytocin may be administeredby intramuscular injection, e.g., at an amount of 0.1 μg to 1000 μg,including 1 μg to 100 μg, 5 μg to 50 μg, 10 μg to 30 μg etc.

In certain aspects, a method for enhancing proliferation of a somaticcell is provided. The method may include contacting the somatic cellwith oxytocin receptor (OXTR) agonist and ALK5 antagonist, where thecontacting is with an amount of the OXTR agonist and ALK5 antagonisteffective to enhance proliferation of the somatic cell, where thecontacting is for a period of time sufficient to provide for enhancedproliferation of the somatic cell compared to the absence of the OXTRagonist and ALK5 antagonist. In certain aspects, the combinedadministration of the OXTR agonist and ALK5 antagonist provides asynergistic effect where the effective amounts the OXTR agonist and ALK5antagonist is lesser that the amount required to enhance proliferationof the somatic cell when the somatic cell is contacted with either theOXTR agonist or the ALK5 antagonist.

In certain aspects, the effective amount of the OXTR agonist whenadministered in combination with the ALK5 antagonist may be 10% less,20% less, 30% less, 40% less, 50% less, 60% less, or lesser than theamount of the OXTR agonist required to achieve the same effect whenadministered in absence of the ALK5 antagonist. In certain aspects, theeffective amount of the ALK5 antagonist when administered in combinationwith the OXTR agonist may be 10% less, 20% less, 30% less, 40% less, 50%less, 60% less, or lesser than the amount of the ALK5 antagonistrequired to achieve the same effect when administered in absence of theOXTR agonist. Thus, the combined administration of the OXTR agonist andthe ALK5 antagonist allows lowering the doses of each molecule, thus notskewing the respective pathways far from healthy signaling ranges, whilemaintaining and/or even broadening the positive effects on multipletissues and their stem cells.

In certain aspects the combined administration of the OXTR agonist andthe ALK5 antagonist may enhance proliferation of a somatic cell (e.g.,myogenic or neurogenic cell) by at least 10% more, 20% more, 30% more,40% more, 50% more, 60% more, or more than the proliferation affected byeither molecule alone.

In certain aspects the combined contacting with the OXTR agonist and theALK5 antagonist may enhance proliferation of a somatic cell (e.g.,myogenic or neurogenic cell) by at least 10% more, 20% more, 30% more,40% more, 50% more, 60% more, or more than the proliferation of the sametype of somatic cell in absence of the contacting.

In certain cases, the effective concentration of the ALK5 antagonist(e.g., Galunisertib (LY2157299)) may be 0.05 μM-0.75 μM and theeffective concentration of the OXTR agonist (e.g., oxytocin) may be 7.5nM-30 nM for enhancing proliferation of myoblasts. In certain cases, theeffective concentration of the ALK5 antagonist (e.g., Galunisertib(LY2157299)) may be 0.5 μM-3 μM and the effective concentration of theOXTR agonist (e.g., oxytocin) may be 10 nM-30 nM for enhancingproliferation of satellite cells of an old subject.

In certain aspects, the effective concentration of oxytocin may be inthe range of 0.01 to 1 microgram per gram mouse body weight per day. Incertain aspects, oxytocin may be administered by intraperitoneal orsubcutaneous injection, or continually by osmotic pump. In certainaspects, the effective concentration of the ALK5 antagonist (e.g.,2-(3-(6-Methylpyridin-2-yl)-1H-pyrazol-4-yl)-1,5-naphthyridine) may bein the range of 2 to 200 picomoles per gram mouse body weight per day.In certain aspects, the ALK5 antagonist may be administered byintramuscular, intraperitoneal or subcutaneous injection, or continuallyby osmotic pump.

The effective concentrations of the OXTR agonist and ALK5 antagonist fora human subject may be extrapolated from effective concentrationsderived from animal studies. For example, the following conversion tablemay be used for determining human equivalent dose:

TABLE 1 Conversion of Animal Doses to Human Equivalent Doses Based onBody Surface Area To Convert To Convert Animal Dose in mg/kg Animal Dosein to HED^(a) in mg/kg, Either: mg/kg to Dose in Divide Multiply mg/m²,Multiply Animal Animal Species by k_(m) Dose By Dose By Human 37 — —Child (20 kg)^(b) 25 — — Mouse 3 12.3 0.08 Hamster 5 7.4 0.13 Rat 6 6.20.16 Ferret 7 5.3 0.19 Guinea pig 8 4.6 0.22 Rabbit 12 3.1 0.32 Dog 201.8 0.54 Primates: Monkeys^(c) 12 3.1 0.32 Marmoset 6 6.2 0.16 Squirrelmonkey 7 5.3 0.19 Baboon 20 1.8 0.54 Micro-pig 27 1.4 0.73 Mini-pig 351.1 0.95 ^(a)Assumes 60 kg human. For species not listed or for weightsoutside the standard ranges, HED can be calculated from the followingformula: HED = animbal dose in mg/kg × (animal weight in kg/human weightin kg)^(0.33). ^(b)This k_(m) value is provided for reference only sincehealthy children will rarely be volunteers for phase 1 trials. ^(c)Forexample, cynomolgus, rhesus, and stumptail.

As noted above, the somatic cell may be a muscle cell, such as, askeletal muscle cell, cardiac muscle cell, or a myoblast. In certainaspects, the somatic cell may be a precursor cell such as a satellitecell (e.g., Pax7+Myf5+ satellite cells), muscle stem cell, neural stemcell (e.g., Sox-2+ Doublecortin+ hippocampal subgranular zone (SGZ)cells), and the like. In certain aspects the somatic cell may be anactivated satellite cell or a neural cell.

The somatic cell may be a cell of an aged subject as noted above and/oran injured cell. The injury may be caused by either a disease or due toa physical injury.

The contacting maybe in vivo, in vitro, or ex vivo. In certain aspects,the contacting is performed in vitro. For example, the somatic cell maybe cultured in a low mitogen medium and contacted with both the OXTRagonist and the ALK5 antagonist to enhance proliferation of the somaticcell. In certain aspects, the somatic cell may be a liver cell. Incertain aspects, the somatic cell may be albumin+Ki67+ hepatocytes. Inother aspects, the contacting includes administering the OXTR agonistand the ALK5 antagonist to a subject in need thereof.

In certain aspects, a somatic cell may be isolated from a subject, andcontacted with the OXTR agonist and the ALK5 antagonist to enhanceproliferation of the somatic cell and the proliferated somatic cells maybe administered to the subject. The proliferated somatic cells may betransplanted to a particular location in the subject, such as, muscle,spinal cord, brain, bone, lover, pancreas and the like.

The treatment methods may also include an assessment of proliferation ofthe somatic cell following the contacting with the OXTR agonist and theALK5 antagonist. Based on the assessed proliferation or lack thereof,the amounts of the OXTR agonist and/or the ALK5 antagonist may beadjusted by increasing or decreasing the amounts and/or the schedule ofadministration of the OXTR agonist and the ALK5 antagonist.

In certain aspects, the method may include contacting the somatic cellwith only one of the OXTR agonist and the ALK5 antagonist prior to orafter contacting the somatic cell with both the OXTR agonist and theALK5 antagonist.

Pharmaceutical Composition

Aspects of the invention are directed to pharmaceutical compositions fortreatment of a subject. The pharmaceutical compositions may include anOXTR agonist and an ALK5 antagonist. As described above, the OXTRagonist may be any agent that specifically enhances OXTR expression,OXTR signaling, or signaling downstream of the OXTR and the ALK5antagonist may be any agent that specifically reduces OXTR expression,ALK5 signaling, or signaling downstream of the OXTR.

The OXTR agonist and ALK5 antagonist may each be present in apharmaceutically acceptable vehicle. “Pharmaceutically acceptablevehicles” may be vehicles approved by a regulatory agency of the Federalor a state government or listed in the U.S. Pharmacopeia or othergenerally recognized pharmacopeia for use in mammals, such as humans.The term “vehicle” refers to a diluent, adjuvant, excipient, or carrierwith which a compound of the invention is formulated for administrationto a mammal. Such pharmaceutical vehicles can be lipids, e.g.,liposomes, e.g., liposome dendrimers; liquids, such as water and oils,including those of petroleum, animal, vegetable or synthetic origin,such as peanut oil, soybean oil, mineral oil, sesame oil and the like,saline; gum acacia, gelatin, starch paste, talc, keratin, colloidalsilica, urea, and the like. In addition, auxiliary, stabilizing,thickening, lubricating and coloring agents may be used. Pharmaceuticalcompositions may be formulated into preparations in solid, semi-solid,liquid or gaseous forms, such as tablets, capsules, powders, granules,ointments, solutions, suppositories, injections, inhalants, gels,microspheres, and aerosols. As such, administration of the compositioncan be achieved in various ways, including transdermal, intradermal,oral, buccal, rectal, parenteral, intraperitoneal, intradermal,intracheal, etc., administration. The active agent may be systemic afteradministration or may be localized by the use of regionaladministration, intramural administration, or use of an implant thatacts to retain the active dose at the site of implantation. The activeagent may be formulated for immediate activity or it may be formulatedfor sustained release.

The pharmaceutical composition may further include a pharmaceuticallyacceptable carrier. The OXTR agonist and ALK5 may (together orseparately) be formulated into pharmaceutical compositions bycombination with appropriate, pharmaceutically acceptable carriers ordiluents, and may be formulated into preparations in solid, semi-solid,liquid or gaseous forms, such as tablets, capsules, powders, granules,ointments, solutions, suppositories, injections, inhalants and aerosols.As such, the pharmaceutical composition may be suitable foradministration in various ways, including oral, buccal, rectal,parenteral, intraperitoneal, intradermal, transdermal, intracheal, etc.,administration.

Preparations of the pharmaceutical composition may be sterile. Sterilityis readily accomplished by filtration through sterile filtrationmembranes (e.g., 0.2 μm membranes). Therapeutic compositions may beplaced into a container having a sterile access port, for example, anintravenous solution bag or vial having a stopper pierceable by ahypodermic injection needle. The pharmaceutical composition may bestored in unit or multi-dose containers, for example, sealed ampules orvials, as an aqueous solution or as a lyophilized formulation forreconstitution. As an example of a lyophilized formulation, 10-mL vialsare filled with 5 ml of sterile-filtered 1% (w/v) aqueous solution ofcompound, and the resulting mixture is lyophilized. The infusionsolution may be prepared by reconstituting the lyophilized compoundusing bacteriostatic Water-for-Injection. Alternatively, the therapeuticmoiety may be formulated into lotions for topical administration.

Pharmaceutical compositions can include, depending on the formulationdesired, pharmaceutically-acceptable, non-toxic carriers of diluents,which are defined as vehicles commonly used to formulate pharmaceuticalcompositions for animal or human administration. The diluent may beselected so as not to affect the biological activity of the combination.Examples of such diluents are distilled water, buffered water,physiological saline, PBS, Ringer's solution, dextrose solution, andHank's solution. In addition, the pharmaceutical composition orformulation can include other carriers, adjuvants, or non-toxic,nontherapeutic, non-immunogenic stabilizers, excipients and the like.The compositions can also include additional substances to approximatephysiological conditions, such as pH adjusting and buffering agents,toxicity adjusting agents, wetting agents and detergents.

The composition can also include any of a variety of stabilizing agents,such as an antioxidant for example. When the pharmaceutical compositionincludes a polypeptide, the polypeptide can be complexed with variouswell-known compounds that enhance the in vivo stability of thepolypeptide, or otherwise enhance its pharmacological properties (e.g.,increase the half-life of the polypeptide, reduce its toxicity, enhancesolubility or uptake). Examples of such modifications or complexingagents include sulfate, gluconate, citrate and phosphate. The nucleicacids or polypeptides of a composition can also be complexed withmolecules that enhance their in vivo attributes. Such molecules include,for example, carbohydrates, polyamines, amino acids, other peptides,ions (e.g., sodium, potassium, calcium, magnesium, manganese), andlipids.

Further guidance regarding formulations that are suitable for varioustypes of administration can be found in Remington's PharmaceuticalSciences, Mace Publishing Company, Philadelphia, Pa., 17th ed. (1985).For a brief review of methods for drug delivery, see, Langer, Science249:1527-1533 (1990). The components used to formulate thepharmaceutical compositions may be of high purity and are substantiallyfree of potentially harmful contaminants (e.g., at least National Food(NF) grade, at least analytical grade, at least pharmaceutical grade).Moreover, compositions intended for in vivo use may be sterile.

The pharmaceutical composition can be incorporated into a variety offormulations. More particularly, the therapeutic moiety may beformulated into pharmaceutical compositions by combination withappropriate pharmaceutically acceptable carriers or diluents.

Kits

Aspects of the invention include a kit for treatment of a subject. Thekit may include an OXTR agonist and an ALK5 antagonist inpharmaceutically acceptable vehicles as described above. The OXTRagonist and ALK5 antagonist may each be present in solid, semi-solid,liquid or gaseous forms, such as tablets, capsules, powders, granules,ointments, solutions, suppositories, injections, inhalants and aerosols.As such, the pharmaceutical composition may be suitable foradministration in various ways, including oral, buccal, rectal,parenteral, intraperitoneal, intradermal, transdermal, intracheal, etc.,administration.

In addition to the above components, the subject kits may furtherinclude instructions for practicing the subject methods. Theseinstructions may be present in the subject kits in a variety of forms,one or more of which may be present in the kit. One form in which theseinstructions may be present as printed information on a suitable mediumor substrate, e.g., a piece or pieces of paper on which the informationis printed, in the packaging of the kit, in a package insert, etc. Yetanother means would be a computer readable medium, e.g., diskette, CD,DVD, portable flash drive, etc., on which the information has beenrecorded. Yet another means that may be present is a website addresswhich may be used via the internet to access the information at aremoved site.

Utility

OXTR agonists may be used to treat and prevent sarcopenia, improvemuscle regeneration after injury and prevent muscle mass loss observedafter long term immobilization (bed rest or cast), as well as lowgravity (space travel). Specifically, oxytocin is more desirable thanother drugs on the market or under development, since it is physiologic,has virtually no side effects and is already FDA approved to inducelabor in pregnant women and in clinical trials to treat children withautism. The plasmatic level of oxytocin decreases with age in mice. Ashort term subcutaneous injection (systemic delivery) of oxytocin isable to restore muscle regeneration in old mice and conversely, theinjection of an oxytocin antagonist in young mice prematurely ages theirmuscle regeneration potential (see Elabd et al. (2014) NatureCommunications 5:4082). Confirming the dependence of muscle maintenanceand repair on oxytocin, mice with a knock out in oxytocin have defectivemuscle regeneration and premature sarcopenia (loss of muscle tissue).Oxytocin is also known to prevent osteoporosis and regulate fatdistribution after menopause. Oxytocin inhibits p16 (marker and effectorof senescence) in adult stem cells, thereby enabling their productiveresponses to maintain and repair tissues. The positive effects ofoxytocin can be further supplemented by the small molecule inhibitor ofTGF-beta receptor (ALK5 inhibitor), which simultaneously rejuvenatesmyogenesis and neurogenesis and reduces inflammation, when deliveredsystemically into 2-year old mice (equivalent of ˜85 year old human).

Summarily, systemic delivery of oxytocin and Alk5 inhibitor is capableof combating and reversing the aging of multiple tissues, includingmuscle, brain and bone and is effective in down-modulating cellularsenescence, reducing inflammation and reducing obesity (known to beassociated with and exacerbate metabolic disorders). The mixture ofthese two molecules enables the long-term applications, in which eachdrug is not used at a high dose, therefore, the negative effects ofdown-regulation of TGFβ signaling and/or up-regulation of MAPK/pERKsignaling are minimized, while the positive effects on health,maintenance and repair of multiple tissues and organs are maximizedand/or optimal.

A combination of oxytocin (or another OXTR agonist) with Alk5 inhibitormay be used to potentiate the positive effects on muscle, bone, combatage-related fat deposition and to promote and rejuvenate hippocampalneurogenesis (leading to increase in memory and cognition and preventingloss of memory and cognition in the elderly).

EXAMPLES Example 1 Alk5i and Oxytocin Enhance Proliferation of Muscleand Neural Cells

CDK inhibitors (CDKIs) become up regulated with age in the satellitecells and in SGZ cells (FIG. 1). Such increase is in part due to theage-elevated TGF-beta/pSmad2, 3 in both muscle stem cells and in theSox-2+ neural SGZ stem cells. Accordingly, Alk5i attenuates theexpression of CDKIs and enhances myogenesis and neurogenesis in the agedmice; systemically administered Alk5i has central effectsdown-modulating pSmads in Sox-2+ cells of SGZ.

FIG. 1. CDKIs increase with age in muscle stem cells and neural stemcells. Age-specific up regulation of CDKIs in muscle stem cells at 3 DPIand in hippocampal SGZ cells (studied by qRT PCR). The levels of p21 arealso increased in quiescent old muscle stem cells where p16, p21 lociare more open epigenetically in the old cells, as compared to youngcells, and CDKI proteins are also elevated with age in satellite cells.Young cells (left bar); old cells (right bar).

Age-related decline in myogenesis is accompanied by decrease in musclestrength and lean mass (FIGS. 2A and 2B). FIG. 2A. Gasctroc muscle (GA)was dissected at the distal tendon (Achilles) and contractile forces,single twitch (s) and maximal tetanic force (max), were measured underelectro-stimulation at the Sciatic nerve. Shown are mean values foryoung (Y, 3 mo, 4 mice) and old (0, 23 mo, 8 mice), +/−S.E.M. withp-values shown. FIG. 2B. Percent body fat and lean mass 2-4 month and12-20 month, B6129S mice were measured live by quantitative magneticresonance (EchoMRI 100 H, Houston, Tex.). Shown are mean %+/−S.E.M.*p<0.05 n=5-9.

The correlation between the decline in muscle stem cell responses andloss of muscle size, fiber diameter and accumulation of fat is alsoevident in the oxytocin knock out (OtKO) mice at 1 year of age; oxytocin(OT) rescues the OtKO satellite cell decline. OT activates pERK inmuscle stem cells, attenuates CDKIs enhances proliferation andmyogenicity of the old satellite cells, while OTA inhibits myogenicityof the young satellite cells.

Initial doses of Alk5i+OT that enhance proliferation of primarymyoblasts and neural precursor cells (NPCs) in the low mitogen media andthe doses that enhance myogenic proliferation of old satellite cells inold serum (better than OT and Alk5 alone at such doses) have beendefined (FIG. 3A-C).

FIGS. 3A-3C depict dose-curve matrices of OT, Alk5i and OT+Alk5i effectson myogenic and neurogenic cell proliferation. FIGS. 3A-3C show theeffect of the indicated concentrations of OT (in nM) and Alk5-inhibitor(a5i, μM) on primary myoblasts in Opti-MEM (FIG. 3A); on old satellitecells isolated from 3 DPI muscle in Opti-MEM with 5% old mouse serum(FIG. 3B); and on rat neural precursor cells in basal medium(DMEM/F12/N2) (FIG. 3C). Cells were pulsed with BrdU, and BrdUimmunodetection and Hoechst staining were performed. Percentproliferating cells (myogenic and neurogenic) were quantified (manually,by ImageJ and by Molecular Devices ImageXpress Micro automatedepifluorescence imager, with automated cell quantification byMetaXpress). Shown is the percent proliferation visualized as atopographic map.

Alk5i has bi-phasic effect on myoblast proliferation (consistent withthe bi-phasic effects of TGF-β1 that is needed at some levels, butbecomes inhibitory when elevated. At certain doses OT+Alk5i enhancemyoblasts, old satellite cell and NPC proliferation more than eachmolecule alone. Increase in Alk5i diminishes proliferation of NPCs,which have low endogenous pSmad2,3; hence TGF-β1/pSmad is needed for NPCproliferation at some levels; interestingly OT+Alk5i rescues NPCproliferation, suggesting pathway cross-talk.

EXAMPLE Epistasis Between TGF-Betal and Oxytocin

Further support for the advantages of the combined administration of OTand Alk5i comes from the observation of epistasis between the TGF-beta1and oxytocin. While ectopic TGF-beta 1 inhibited muscle regeneration ineven young muscle after an injury in mice, systemic OT rescued muscleregeneration after an injury in mice administered with ectopicTGF-beta1.

FIGS. 4A and 4B show the in vivo epistasis between TGFβ1 and Oxytocin.Young (3 mo) mouse TA muscles were injured with CTX with or withoutrecombinant TGFβ1 (20 ng/muscle), and mice were administered 1 μg/g OTor vehicle (HBSS) by sub-cutaneous delivery into circulation. TGFβ1 orvehicle and OT were administered again the following day. Mice weresacrificed 5 days after injury and muscle sectioned for histologicalexamination (with Hematoxilin and Eosin staining) in 10 um cryosections.All samples were processed and analyzed in a blinded study. FIG. 4Ashows young control muscle regenerates well with many newly formed smallmuscle fibers with central nuclei. Ectopic TGFβ1 promotes scarring(white areas) and increased numbers of infiltrating mono-nucleatedleukocytes in the young muscle, as typical of old poorly regeneratingtissue. Systemic OT rescues the regeneration of young muscle injectedwith TGFβ1 making it similar to that of young muscle control. FIG. 4Bdepicts the regenerative index of the three different conditions. Theregenerative index was quantified by expressing the number of newlyformed fibers over total nuclei in the injury/regeneration sites;*p<0.01.

Example 3 Optimal Doses of Alk5i and Oxytocin That Enhance Proliferationand Attenuate CDKIs of Muscle and Neural Cells

The doses of Alk5i and Oxytocin (OT) that enhance proliferation andattenuate CDKIs while minimally interfering with pSmad2, 3 and pERK willbe studied in primary myoblasts and NPCs cultured in low mitogen medium.

Primary myoblasts and separately, NPCs will be plated for 24 hours at10³ cells in 100 μl per well in 96 well plates in mitogen-free medium(Opti-MEM and Neurobasal A/B27, respectively) and exposed to the dosecurve of concentrations of the Alk5i (Enzo ALX-270-445) and OT (Anaspec#24275). The effects of single molecules and their combinations at awide range of doses (from 30 uM to 1 uM for OT, from 3 uM to 0.1uM) willbe tested. Myoblasts and NPCs will be pulsed with BrdU for the last 4hours of culture and analyzed by immunofluorescence with anti-BrdUantibodies. Percent of proliferating BrdU+cells out of total Hoechst+cells will be quantified.

CDKIs expression and pSmad2, 3, as well as, pERK signaling intensitieswill be determined in these primary myoblasts and NPCs exposed to therange of Alk5i and OT concentrations by qRT PCR (for CDKIs, usingspecific primers and GAPDH signal for normalization) and by WesternBlotting using anti-p15, p16, p21 and p27 antibodies; anti-pSmad2,anti-pSmad3 antibodies and anti-pERK1, 2 antibodies. The levels of theseproteins will be normalized by the housekeeping genes (e.g. GAPDH orcytoplasmic beta-actin) and for the phosphorylated proteins also by thetotal Smad 2 and 3 (for pSmads) and by total ERK (for pERK1, 2). Thelevels of CDKIs, pSmads and pERKs will be quantified, based on thenormalized pixel density. 10⁴ cells will be used for qRT PCR and 5×10⁵cells per Western Blotting.

The optimal doses of Alk5i and OT that enhance myogenicity of freshlyisolated old muscle stem cells cultured with old mouse serum anddown-regulate CDKIs in these cells, while not changing the pSmad 2, 3and pERK significantly below/above (respectively) the young range, willbe defined.

Myofiber-associated muscle stem cells will be derived fromcardiotoxin-injured muscles of young and old mice and will be culturedat 10³ cells per well of 96 well plates, in 100 μl of Opti-MEM with 5%of their own serum (young or old) per well. These freshly isolatedmuscle stem cells will be exposed to the above-specified range of Alk5iand OT concentrations for 24 hours, examining the effects of singlemolecules and their mixture. By 24 hours in these conditions, activatedby injury, young satellite cells form robustly proliferating myogeniccolonies, while such proliferation of the aged myofiber-associatedsatellite cells is dramatically diminished. BrdU and Pax7 as well as theKi67 and Pax7 co-detection will be used to determine the proliferationefficiency of muscle stem cells (in the presence of their own serum).Hoechst will label all nuclei. BrdU will be added for the last 4 hoursof culture. The percent of BrdU+/Pax7+ and Ki67+/Pax7+ cells out oftotal Hoechst+ cells will be identified.

qRT PCR for CDKIs and Western Blotting for pSmad2, 3, pERK1, 2 and CDKIsp15, p16, p21 and p27 will be performed, using 5×10⁴ cells for each qRTPCR assay and 1×10⁵ cells per each Western Blotting; the expressionlevels of these proteins will be quantified, as described above forprimary myoblasts.

The doses of Alk5i and OT that enhance proliferation of myoblasts and ofNPCs in the low mitogen medium and the doses that enhance myogenicproliferation of old satellite cells in old serum will be identified.When added together, Alk5i and OT will have such an effect at lowerdoses then when used alone. Attenuation of pSmad2, 3 by Alk5i andinduction of pERK1, 2 by OT will be less pronounced when these moleculesare combined at low doses, while the down-regulation of CDKIs will bestronger than produced by each molecule at such low dose alone.Differences in the dose-curve effects of Alk5i, OT and Alk5i+OT betweenmyoblasts and NPCs will be revealed. Rat and mouse NPCs respondsimilarly to the attenuation of TGF-beta and will internally control theresults.

Materials and Methods

Animal Strains: C57.B6 male and female 2-3 month old mice (young mice)will be obtained from Jackson Labs; C57.B6 male and female 22-24 monthold mice (old mice) will be obtained from the NIA. B6; 1295-Oxttm1Wsy/Jmale mice will be obtained from Jackson Labs, and bred, genotyped andaged. These Ot knockout mice display premature sarcopenia (smallermuscle, smaller fiber size, markedly decreased muscle regeneration afterCTX injury, significantly diminished activation/proliferation of musclestem cells, and pronounced obesity).

Isolation of Muscle Stem Cells and Primary Myoblasts: Tibialis Anterior(TA) and Gastrocneimus (Gastroc) muscles will undergo enzymaticdigestion with collagenase type II. Fat pads and tendons will be removedand rounds of muscle trituration and sedimentation will purify myofiberswith associated muscle stem (satellite) cells. Myofibers will beincubated with collagenase type II and dispase; suspensions will bevortexed to release satellite cells from digested fibers, passed througha cell strainer and pre-plated on uncoated dishes for 20 minutes at 37°C., 5% CO₂. Cells that do not adhere during pre-plating are ˜95% pure(Pax7+ and/or Myf5+) robustly myogenic muscle stem (satellite) cells.Primary proliferating myoblast cell lines (Pax7+, MyoD+, desmin+) aregenerated from these muscle stem cells by 1-2 weeks of culture in Ham'sF10, 20% FBS, 5 ng/ml FGF-2. In Opti-MEM and in DMEM, 2% horse serum,these primary myoblasts differentiate into myocites and myotubes orbecome non-mitotic reserve cells.

Isolation and Culture of Neural Progenitor Cells: Primary rat neuralprogenitor cells (NPCs) isolated from the hippocampi of Fisher 344 rats(Charles River) will be maintained in DMEM/F12 (Life Technologies)containing N2 supplement (Life Technologies) and 10 ng/mL FGF-2(PeproTech) on laminin (Roche) and polyornithine (Sigma) coated tissueculture plates. Primary mouse NPCs will be isolated from hippocampi ofyoung male C57B6 mice and maintained in Neurobasal A medium (Gibco) withB27 supplement (Gibco), Glutamax-1 supplement (Gibco), 20 ng/mL FGF-2(Peprotech), and 20 ng/mL EGF on Poly-d-Lysine and Laminin coated tissueculture plates. Primary mouse NPCs will be isolated from Ot knockoutmice in a similar manner.

Statistical Analysis: Quantification and statistical Analysis by ANOVAwill be performed for 3-5 entirely independent experiments, (startingwith muscle stem cell preparation, myoblasts or NPCs, and all in vivostudies) and cell proliferation, qRT PCR, Qiagen and R&D arrays, WesternBlotting, tissue histology and sections immunofluorescence, Echo-MRI andmuscle strength assays with be performed in triplicate. These numbersare based on power analysis and IACUC considerations, and all data willbe assessed for significance based on p values and heteroscedasticvariance between groups that are statistically compared. Data will beanalyzed using Student's t-tests (two-tailed) and P values equal orlower than 0.05 will be considered statistically significant. Forquantification of immunofluorescent images for BrdU incorporation intocells, 25 20× images per replicate will be taken on the MolecularDevices ImageXpress Micro automated epifluorescence imager, followed byautomated cell quantification using the multiwavelength cell-scoringmodule within the MetaXpress analysis software. For pixel density inWestern Blotting, Gene Jockey will used to determine integrated pixelintensity with subtracted background, normalized by the pixel density ofhousekeeping genes and for pSmads and pERKs also by theun-phosphorylated total ERK and Smads. The data will be integrated suchthat for every Alk5i and OT dose (alone and as a mix) the rate ofproliferation, myogenesis, neurogenesis, etc. and the levels of studiedCDKIs, pSmads and pERKs are correlated. Statistics for muscle mass,degree of fibrosis, fiber size—Ferrets' diameter, the efficiency ofmuscle repair after CTX injury will be performed. For quantification ofthe number of neurogenic cells, unbiased stereology (Zeiss Axio Imager,software by MicroBrightfield) using the optical fractionator method willbe performed on 8 vibratome coronal brain slices spanning thehippocampus (40 microns thick, 200 microns apart), and the number ofselected cells will be normalized by the volume of hippocampal tissue.Cell numbers will be normalized to the volume of the DG granule celllayer measured by ImageJ. For pixel intensity and percent areaquantifications of immunofluorescent images, MetaXpress AnalysisSoftware will be used.

Example 4 Relationship Between TGF-Beta/pSmad2, 3 and OT/MAPK In Vivo

In the pharmacological approach, systemic Akl5i will be administeredsimultaneously with the antagonist of oxytocin, OTA (L-371,257 Tocris#2410) and in separate experiments, systemic OT will be deliveredsimultaneously with ectopic TGF-beta1 to mice. Each molecule alone(Alk5i, OT, OTA and TGF-beta1) and control vehicle (HBSS) will be usedfor comparison. The regeneration of TA and Gastroc muscle after aninjury and ongoing neurogenesis (SGZ) will be assayed. Young (2-3 mo)C57.B6 male mice will be used in these studies, due to expected highersignal to noise ratio: old animals already have high levels ofTGFβ1/pSmad2, 3 and low levels of OT/MAPK; and in old mice, Alk5i alonesignificantly enhances myogenesis and neurogenesis while OT alonesignificantly enhances muscle maintenance and repair.

Physiologically effective doses of these molecules will be used. C57B6young male mice will have intraperitoneal delivery of TGF-β1 Type IReceptor Kinase Alk5 inhibitor, Alk5i,2-(3-(6-Methylpyridin-2-yl)-1H-pyrazol-4-yl)-1,5-naphthyridine (EnzoALX-270-445 0.2 nmol/g mouse in sunflower oil), alone or together withOTA (L-371,257 Tocris #2410 2 μg/g mouse); and in separate experiments,with TGF-beta1 (R&D systems), alone or together with OT (Anaspec #242751 ug/g mouse). Mice will receive 20 μl injections of these molecules orvehicle control (HBSS) once daily for 9-14 days (4 days prior to muscleinjury and then daily for 5-10 days). TA and Gastroc muscle will beinjured with cardiotoxin (CTX) and muscle will be isolated postmortem,at 3 days, 5 days and 10 days post injury (DPI). The animals willreceive 7 daily IP BrdU/EDU injections: (50 mg/kg of body weight) tolabel mitotic cells. Four hours (or alternatively, 5 days) afterreceiving the last BrdU/EDU IP injection, the mice will be perfused, andbrains and TAs, Gastrocs will be collected for analysis. The effects ofthe down-modulation of TGF-beta/pSmad3 signaling when OT is inhibited byOTA and the effects of elevated TGF-beta1 in the presence of ectopic OTwill be determined by assaying muscle repair and the efficiency ofhippocampal neurogenesis (as compared to: control vehicle, OTA alone andTGF-beta1 alone).

Muscle injury and the efficiency of muscle regeneration will bedetermined. Gastroc and TA muscles will be injected with cardiotoxin 1(CTX, Sigma). For myogenic proliferation BrdU/EDU and desmin, as well asKi67 and Pax7 will be co-immuno detected in 10 um muscle sections(derived from muscle isolated at 3 days post injury); for muscle repair,10 um muscle sections (derived from muscle isolated at 5 and 10 dayspost injury) will be stained with Hematoxylin and Eosin and Gomoritrichrome for histology analysis and assaying fibrotic index; andimmunodetection of eMyHC and BrdU/EDU will be used to quantifythroughout the injury site the numbers of de novo eMyHC+ myofibers withcentrally-located BrdU+/EDU+ nuclei that robustly appear in young, butare lacking in the old injured muscle.

The efficiency of hippocampal neurogenesis will be determined. Mice willbe anesthetized and perfused with saline and 4% PFA. Brains will becollected and placed in 4% PFA overnight, followed by dehydration in 30%sucrose/PBS at 4° C. for 2 days and sectioning at 40 μm using avibratome. Sections will be co-immunostained with antibodies to Sox-2and BrdU or EDU (to determine the numbers of proliferative neural stemcells). After a longer chase period (5 days after the last BrdU or EDUinjections) co-immunodetection of Doublecortin (DCX) and BrdU or EDUwill be used to identify the numbers of more downstream type 2bDoublecortin expressing transit amplifying cells. Immunodetection willbe performed, and images will be taken with a prairie confocalmicroscope.

CDKIs expression and pSmad2, 3, pERK1, 2 levels in vivo will bedetermined at all studied time points in 5×10⁵ freshly-derived musclestem cells from TA and Gastroc and in dissected hippocampi of these miceby qRT PCR (for CDKIs) and by Western Blotting for CDKIs, pSmad2,pSmad3, pERK1, 2. Pixel intensity of pSmad2, 3, pERK1, 2 and of CDKIwill be assayed in Pax7+ cells of TA and in Sox-2+ cells andDoublecortin+ cells of SGZ by immunofluorescence in tissue sections.

In the genetic approach, Alk5 inhibitor will be administered to1-year-old Ot KO mice and effects on myogenesis and hippocampalneurogenesis will be studied. Age-matched WT littermates and young (2-3mo) Ot KO mice will serve as controls for all experiments.

B6;1295-Oxttm1Wsy/J male mice will be purchased from Jackson Labs andbred, genotyped and aged. While there are no developmental or early lifedefects, by 1 year of age, as compared to the WT littermates, Ot KO micedisplay premature sarcopenia: smaller muscle, smaller fiber size,markedly decreased muscle regeneration after CTX injury andsignificantly diminished activation/proliferation of muscle stem cells,as well as pronounced obesity.

Alk5i (Enzo ALX-270-445 0.2 nmol/g mouse) will be administeredintraperitoneally to the 1 year old Ot KO male mice for 9-14 days (4days prior to muscle injury and then daily for 5-10 days). TA andGastroc muscle will be injured with CTX, and muscle will be isolatedpostmortem, at 3, 5 and 10 days post injury. Prior to sacrifice, theanimals will receive 7 daily IP BrdU/EDU injections: (50 mg/kg of bodyweight) to label mitotic cells. Four hours (or alternatively, 5 days)after receiving the last BrdU/EDU injection, the mice will be perfused,and brains and TAs, Gastrocs will be collected for analysis.

The effects of the down-modulation of TGF-beta/pSmad3 signaling when OTis genetically lacking will be determined by assaying muscle maintenanceand repair and hippocampal neurogenesis. For muscle, muscle mass, fibersize, the efficiency of muscle repair after CTX injury (numbers ofde-novo eMyHC+ myofibers and degree of fibrosis and theactivation/proliferation of muscle stem cells in vivo), muscle strength,and body fat content (by Echo-MRI). The efficiency of hippocampalneurogenesis will be assayed by quantifying the numbers of proliferatingSox-2+ neural stem cells and Doublecortin+ cells.

CDKIs, pSmad2, 3, and MAPK/pERK levels will be determined at all studiedtime points in 5×10⁵ freshly derived muscle stem cells (TA, Gastroc) andin dissected hippocampi of these 1 year old Ot KO mice administered withAlk5i, or vehicle control (using cells and tissues of WT littermates andof 2-3 mo Ot KO mice for comparison). Cells and tissues will be studiedupon isolation by qRT PCR (for CDIKs, with specific primers, using GAPDHfor normalization) and by Western Blotting on p15, p16, p21, p27,pSmad2, 3, pERK1, 2. Pixel intensity of pSmad2, 3, pERK1, 2 and of CDKIwill be also assayed in Pax7+ cells of TA and in Sox-2+ cells andDoublecortin+ cells of SGZ of these Ot KO mice treated with Alk5i, orvehicle control, by immunofluorescence in tissue sections.

Whether attenuation of TGF-beta/pSmad2, 3 by Alk5i overrides theinhibitory effects of oxytocin antagonist on myogenesis and/orneurogenesis possibly down-regulating CDKIs in muscle and/or hippocampuswill be determined. It will be determined that Alk5i simultaneouslyenhances myogenesis and neurogenesis and attenuates CDKIs in old WTmice. Whether ectopic oxytocin can ameliorate the inhibitory effects ofexcessive TGF-beta1 on hippocampal neurogenesis and myogenesis andreduce CDKIs will also be determined. A correlation between tissuemaintenance and repair in Ot KO animals and the levels of CDKIs in theirmyogenic and neurogenic regions will be defined.

Example 5 Comparison of the Effects of Systemic Administration of Alk5iand OT Mixtures to Old Male and Female Mice to Heterochronic Parabiosis

Heterochronic parabiosis studies have provided a proof of principle thattissue stem cells residing in an old mammal are capable of productiveregenerative responses; boosting old stem cells can enhance themaintenance and repair of multiple organs, preventing or amelioratingdebilitating degeneration of muscle, bone, liver, brain, etc. thatinvariably accompany human aging. Importantly, young mice sharing bloodwith old animals experienced a regenerative decline in a number oftissues demonstrating the presence of systemic inhibitors of stem cellresponses in the old circulation. Studies on heterochronic parabiosissuggest that the activity of tissue stem cells can be modulated bysystemic factors that change with age.

The degree to which longer-term simultaneous systemic administration ofAlk5i and OT (2-3 months) emulates the positive effects of heterochronicparabiosis on myogenesis, hippocampal neurogenesis and liverregeneration in old mice, will be tested. Muscle mass and contractilestrength, fiber size, lean vs. fat body content, tumor pathologies andthe expression of key tumor suppressors and oncogenes will be examined.Male and female C57.B6 mice will be used.

Physiologically effective doses of these molecules that producesignificant results in muscle and brain will be used: for Alk5i alone (2ug/g mouse) and OT alone (1 ug/g mouse). Alk5i+OT will be used at theoptimal doses (lower than each molecule alone) that enhance myogenicproliferation of old muscle stem cells cultured with old (e.g., 0.2ug/g/day mouse for Alk5i and 0.1 ug/g/day mouse for OT). SubcutaneousAlzet pumps will be used for continuous delivery into circulation ofthese molecules or vehicle control (HBSS) for 2-3 months.

Heterochronic parabiosis will be established between young (2-3 mo) andold (22-24 mo) C57B6 mice. Male-to-male and female-to-female pairs willbe used. Control isochronic parabioses will be between two animals ofthe same age and gender (i.e. old male pairs, old female pairs, youngmale pairs and young female pairs). One partner will be GFP transgenic(Jackson #006567). Blood chimerism is established by 7-10 days ofparabiosis and will be tested by assaying GFP+ leukocytes in circulationof C57.B6 mice (by FACS from tail bleeds).

Assays of muscle regeneration after CTX injury will be performed byquantifying in 10 um muscle sections myogenic cell proliferation at 3days post injury and the formation of de novo eMyHC+ myofibers, and thefibrotic index at 5 and 10 days post injury. The “Fibrotic Index” willbe calculated as:

(1−(total eMyHC+ fibers area/total injury area)×100%

One week prior to sacrifice the animals will receive 7 daily IP BrdU/EDUinjections: (50 mg/kg of body weight). Four hours (or alternatively, 5days) after receiving the last BrdU/EDU IP injection, the mice will beperfused, and hippocampal neurogenesis will be assayed by quantifying inbrain sections the numbers of proliferating Sox-2+ cells in SGZ and oftype 2b Doublecortin expressing transit amplifying cells.

Liver maintenance/ongoing hepatocyte proliferation will be assayed byquantifying albumin+Ki67+ and albumin+BrdU+ hepatocytes near portals in10 um tissue sections.

CDKIs expression and pSmad2, 3, pERK1, 2 levels: will be determined atall studied time points in 1-5×10⁵ freshly-derived muscle satellitecells from TA and Gastroc and in dissected hippocampi of these mice byqRT PCR (for CDIKs) and by Western Blotting for CDKIs, apSmad2, pSmad3,pERK1, 2. Pixel intensity of pSmad2, 3, pERK1, 2 and of CDKI will beassayed in Pax7+ cells of TA and in Sox-2+ cells and Doublecortin+ cellsof SGZ by immunofluorescence in tissue sections.

Muscle mass, size, fiber diameter will be determined for uninjured andCTX injured muscle (TA and Gastroc) at 10 and 14 days post injury. TAand Gastroc muscle will be weighed, fiber surface area and Feret'sminimum diameter will be measured using Image J software musclecross-sections. Volumetric measurements of intramuscular andperimuscular fat will be also performed in dissected hind legs. Lean vs.fat body content will be determined by Echo-MRI on live mice.

For direct assay of muscle strength, perimortem muscle force generationwill be performed. The TA tendon will be tied with a 5-0 silk thread inorder to attach the muscle to a force transducer electric stimulator(Grass Tech, Astro-Med Inc.). Supramaximal voltage square wave pulseswill be performed at duration of 0.1 ms at the muscle's optimal length.Tetanic single trains will be performed at a duration of 0.5 s. Maxisometric tetanic force will be determined by the frequency at which noincrease in tetanic force is seen. Data will be acquired through apolyview 16 chart recorder (Grass Tech, Astro-Med Inc.) at a samplingrate of 4000 Hz. Muscle twitch force, maximum isometric contractileforce, maximum rate of force development, rate of muscle relaxation willbe calculated and normalized to its wet weight and cross section area.

Presence and types of cancers will be analyzed by pathology and thepropensity for oncogenic transformations will be studied usingmanufacturers' protocols by The Mouse Oncogenes & Tumor Suppressor GenesRT² Profiler™, PyroMark CpG Assays (Qiagen), and Proteome Profiler MousePhospho-RTK Array Kit, (R&D) in samples of muscle, brain, liver, lung,ovaries, testes, mammary, colon, intestine, bone, etc.

The effects of Alk5i on TGF-beta/pSmad2, 3 and OT/MAPK will be comparedwith those of heterochronic parabiosis. Alk5i+OT mix (where eachmolecule is used at a lower dose than when added alone) will attenuateCDKIs without overtly altering the pSmad 2, 3 and pERK1, 2. The effectsof heterochronic parabiosis on pSmad2, 3, pERK1, 3 and CDKIs will becomparatively determined in males and females. Young males and femaleswill serve as gender-specific positive controls. Gender-specificdifferences will be uncovered in the old male and female mice treatedwith Alk5i, or OT, or Alk5i+OT.

1. -37. (canceled)
 38. A composition comprising: an OXTR agonist; anALK5 antagonist; and a pharmaceutically acceptable excipient.
 39. Thecomposition of claim 38, wherein the amount of the OXTR agonist is inthe range of 7.5 nM-30 nM.
 40. The composition of claim 38, wherein theamount of the ALK5 antagonist is in the range of 0.05 μM-3 μM.
 41. Thecomposition of claim 38, wherein the ratio of the OXTR agonist to theALK5 antagonist is 1:50.
 42. The composition of claim 38, wherein theratio of the OXTR agonist to the ALK5 antagonist is 50:1.
 43. Thecomposition of claim 38, wherein the ratio of the OXTR agonist to theALK5 antagonist is 1:40.
 44. The composition of claim 38, wherein theratio of the OXTR agonist to the ALK5 antagonist is 1:30.
 45. Thecomposition of claim 38, wherein the ratio of the OXTR agonist to theALK5 antagonist is 40:1.
 46. The composition of claim 38, wherein theratio of the OXTR agonist to the ALK5 antagonist is 1:25.
 47. Thecomposition of claim 38, wherein the ratio of the OXTR agonist to theALK5 antagonist is 25:1.
 48. The composition of claim 38, wherein theratio of the OXTR agonist to the ALK5 antagonist is 1:10.
 49. Thecomposition of claim 38, wherein the ratio of the OXTR agonist to theALK5 antagonist is 10:1.
 50. The composition of claim 38, wherein theratio of the OXTR agonist to the ALK5 antagonist is 1:5.
 51. Thecomposition of claim 38, wherein the ratio of the OXTR agonist to theALK5 antagonist is 5:1.
 52. The composition of claim 38, wherein theratio of the OXTR agonist to the ALK5 antagonist is 1:1.
 53. Thecomposition of claim 38, wherein the OXTR agonist is oxytocin.
 54. Thecomposition of claim 38, wherein the ALK5 antagonist is2-(3-(6-Methylpyridin-2-yl)-1H-pyrazol-4-yl)-1,5-naphthyridine.
 55. Useof an OXTR agonist and an ALK5 antagonist for enhancing proliferation ofa somatic cell, the use comprising contacting a somatic cell withoxytocin receptor (OXTR) agonist and ALK5 antagonist, wherein thecontacting is with an amount of the OXTR agonist and ALK5 antagonisteffective to enhance proliferation of the somatic cell. 56.-72.(canceled)